An ectopic pregnancy is when a fertilized egg implants at any other site in the body except Uterus. Most commonly this phenomenon occurs in fallopian tubes in majority of the cases and rarely it may also happen in ovary or elsewhere in abdomen as well. Major risk in these cases is that of rupture of these thin fallopian tube as this pregnancy grows. A rupture can lead to major internal bleeding which is a life threatening emergency and requires surgery immediately.
One wonders, why an ectopic pregnancy would occur in the first place in some women. There are some risk factors which increase this risk. Majority of these risk factors are because of damage to the inner lining of fallopian tubes thus leading to poor movement of fertilized egg through fallopian tubes thus causing implantation of pregnancy in the tube itself. These risk factors are pelvic inflammatory disease, prior ectopic pregnancy, prior fallopian tube surgery, previous pelvic surgery, endometriosis etc. Some other risk factors are cigarette smoking, history of inability to conceive, use of assisted reproductive technology , such as IVF and sometimes older age.
An ectopic pregnancy may be completely silent till it ruptures and leads to massive internal bleeding which may present as sudden severe pain the abdomen, fainting, dizziness etc or may present as abnormal vaginal bleeding, low back pain or mild pain in abdomen or pelvis. A woman may experience either a missed period making her think she is pregnant or a period which is lighter in flow than her usual period. Urine pregnancy kit test may show faint positive. Diagnosis is made on an ultrasound along with a blood test called as beta hcg levels.
An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. There are two methods used to treat an ectopic pregnancy which depends on the stage at which it gets detected, medication till it has not ruptured and surgery for a ruptured or large unruptured ectopic pregnancy. Several weeks of follow-up are required with each treatment.
An obstetrician gynaecologist is the best person to take decision regarding the mode of treatment. A surgery when performed can either be performed laparoscopically or via an open surgery which would depend on factors like condition of the patient, skill of the surgeon etc. Surgery may require removal of damaged fallopian tube or removal of ectopic pregnancy contents after giving a small incision on the fallopian tube.
It should be kept in mind that once an ectopic pregnancy occurs, there is higher risk of ectopic pregnancy again. Thus whenever a pregnancy occurs in future, a woman with previous history of ectopic pregnancy must seek immediate consultation with her Obstetrician Gynaecologist and may be asked to get an early ultrasound with certain blood tests.
Dr. Payal Chaudhary
Obstetrics and Gynaecology
Rosewalk Healthcare by Rainbow Hospitals, New Delhi.